Orthorexia vs. Anorexia

Orthorexia and anorexia both include extreme food restriction, but each one has some important differences. Learn the differences here.

Healthy eating is more popular than ever, and many people are focusing on eating well and avoiding unhealthy or processed foods to improve their overall health.

While eating a healthy and balanced diet has many benefits, it can sometimes be hard to draw the line between healthy eating behaviors and disordered eating. Healthy eating is often accompanied by messages of “clean eating” and “avoiding toxins.” These messages can add moral value to foods, classifying some as “good and clean” and others as “bad and harmful.”

The obsession with healthy eating is known as orthorexia, and people who suffer from it show many signs of disordered eating. Orthorexia and anorexia have many similarities, but there are some key differences in their underlying factors, symptoms, and types of treatment. 

What Is Orthorexia?

Orthorexia is an approach to eating that extends beyond a healthy approach to a balanced diet. It involves obsessing about the nutrient quality or “purity” of foods and only eating kinds deemed to be good or safe. 

Although it is not yet included in the Diagnostic and Statistical Manual for Mental Disorders, orthorexia shares many signs and symptoms with diagnosable eating disorders. For example, someone with symptoms of orthorexia may:

• Obsessively check food labels
• Limit foods or food groups that they may deem “dirty” or “unclean,” such as meat, dairy, carbohydrates, etc.
• Spend significant time and energy anticipating upcoming meals 
• Experience significant distress if they don’t have access to “safe” foods
• Feel guilt or shame for eating “impure” foods
• Not function normally in social, academic or work situations

Orthorexia is also often linked with concerns about body appearance or focus on weight loss. While they may fit the criteria of “eating healthy,” these behaviors are extreme and can be all-consuming as well as very distressing. 

Interestingly, social media use — particularly sites like Instagram — can increase the risk of orthorexia. Contrary to the actual goals of healthy eating, obsessing about healthy eating can actually decrease overall health and wellbeing.

Characteristics of Anorexia

Anorexia is a serious eating disorder characterized by intense fear of weight gain and severe restriction of food. For a clinical diagnosis of anorexia, a person must meet criteria that include:

• Low body weight or body mass index
• Restriction of energy intake
• Persistent behavior to avoid gaining weight
• Abnormal perception of body size and shape, and an unusual amount of self-identity tied to body and appearance

These symptoms and characteristics of anorexia can be linked with serious short- and long-term health consequences and people who suffer from anorexia can have difficulty functioning in their normal daily lives.

Related Topic: Atypical anorexia

Similarities in Presentation

Since orthorexia and anorexia share similar signs and symptoms, it can sometimes be difficult to distinguish between the two. Both disorders include an excessive focus on diet and food while exerting extreme control over what is eaten.

In general, people with both conditions tend to categorize foods as “good” or “bad.” In addition, the thought of having to deviate from strict food rules is incredibly distressing. People with either condition are usually very focused on losing or maintaining weight loss.

Populations Affected

Orthorexia and anorexia are commonly seen in similar groups of people. The groups who are affected by eating disorders are normally people whose body shape, size or function are closely scrutinized. This can include groups like adolescent females, dancers or athletes. Anorexia and orthorexia statistics can help show just how many people are affected.

The lifetime prevalence of anorexia nervosa among adults in the U.S. is estimated to be 0.88%. The exact prevalence of orthorexia is more difficult to track since it is not yet an officially recognized psychiatric disorder. However, estimates suggest that between 6.9% to 57.6% of the general population are affected by orthorexia. Rates might be even higher in certain groups, such as medical students or athletes.

Women make up the majority of the population affected by anorexia, but it’s not yet known whether men or women are more commonly affected by orthorexia. However, eating disorders can certainly affect men and people of all ages. Orthorexia can also be influenced by social media use, which can promote messages regarding the purity of certain foods. Importantly, people with anorexia are also at increased risk of displaying symptoms of orthorexia, even after treatment.

Differences in Motivation: Quality vs. Quantity

The signs and behaviors of orthorexia and anorexia are quite similar. What distinguishes these two conditions is the underlying motivation related to an unhealthy relationship with food.

More specifically, the primary motivator of orthorexia nervosa relates to a desire to be pure, good, clean or healthy. In contrast, anorexia is caused by a drive for thinness and extreme fear of weight gain. While orthorexia can include foods deemed “clean” and healthy, a person with anorexia often aims to avoid or restrict food of any kind.

The motivating factors and causes of orthorexia and anorexia are quite different, but both can lead to extreme obsessions with food and an inability to participate normally in social settings.

Treatment Strategies

Treatments for eating disorders can include a combination of psychological, behavioral and nutritional counseling. There are many treatment strategies for eating disorders, and patients with both anorexia and orthorexia may benefit from one or multiple treatments, including:

• Medication
• Cognitive-behavioral therapy
• Behavioral and food-based interventions (i.e., broadening the range of “acceptable” foods)
• Psychoeducation to unpack beliefs about food

The success of treatment for orthorexia and anorexia may differ based on the type of eating disorder. For example, medication may be more successful in anorexia, but might be considered “unnatural” or inappropriate by someone with orthorexia. For this reason, it is important to discuss the range of treatment options with a professional.

Key Differences Between Orthorexia and Anorexia

Both orthorexia and anorexia include disordered eating behaviors and an obsession with food and appearance, and both are disruptive to a person’s ability to function optimally. Although they share many similarities, there are several key differences between orthorexia and anorexia.

Some of these differences include:

• Anorexia is a recognized psychological condition, whereas orthorexia is not yet recognized in the DSM-5
• Orthorexia is motivated by a desire to be pure; anorexia is driven by a desire for thinness 
• People with orthorexia are not always underweight or driven to be extremely thin, and anorexia is characterized by severely low weight or significant weight loss
• Treatment strategies may differ, based on differences in underlying beliefs about food

Although the two disorders may appear to be similar, these key differences can impact eating disorder prognosis and treatment. Discussion with a professional can help to differentiate between anorexia and orthorexia and find the most appropriate course of treatment. 

If you or someone you care about is experiencing symptoms of anorexia or orthorexia and a co-occurring substance use disorder, contact The Recovery Village today to discuss treatment options. We have facilities located throughout the U.S., and we can help you find a treatment plan that works well for your situation.  

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Dr. Sarah Dash, PHD

Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more